How to Analyze the Atlas Vertebrae in CBCT Scans: A Guide for Dentists & Orthodontists

Helping Your Patients Progress Through Aligners Faster, with Less Discomfort

This post is for dentists, orthodontists, and fellow upper cervical chiropractors because the truth is—we all deal with complex cases. For these cases, sometimes we need to go the extra mile to ensure long-term success for our patients.

And by long-term success, I mean helping them achieve an aligned bite and properly aligned teeth as quickly, smoothly, and effectively as possible—and maintaining it for years to come.

The Key Factor You're Overlooking

I’m going to reveal a key factor that makes cases more complex than they need to be.

Even better—I’ll show you how to screen for it in just 1 minute.

If you catch this before starting aligners or brackets and wires, I can almost guarantee:

✔ Faster treatment progress

✔ Less pain and discomfort

✔ Better long-term stability in their bite and teeth alignment

The Missing Piece: The Atlas Vertebrae (C1)

The key factor? Atlas alignment.

The atlas (C1) is the top bone in the neck—and it needs to be level. No tilting, twisting, or shifting.

If the atlas is crooked due to an old neck injury, dental and orthodontic patients will struggle with aligners, brackets, and wires.

What Happens if You Try to Change Their Bite with a Misaligned Atlas?

❌ Slower progress

❌ More pain in the head, neck, jaw, and throat

❌ Less compliance with permanent retainers

Why Does This Happen?

Short version: A crooked atlas triggers muscle spasms in the head, neck, jaw, and throat. The brain sees a misaligned atlas as a threat to the brainstem and responds by tightening muscles to protect it.

Long version: Check out my 40-minute deep dive on YouTube, where I explain how an atlas misalignment can contribute to:

• Bite problems

• Airway issues & sleep apnea

• TMJD

• Neck pain & more

I also cover the most common causes of a misaligned atlas—car accidents, sports injuries, and falls.

How to Screen for Atlas Misalignment

If you’re open to incorporating this into your patient evaluations, here’s your roadmap:

1. Intake Form – Identify Risk Factors

✅ Ask about past neck injuries, including car accidents and sports injuries

✅ Review surgical history (e.g., a broken collarbone from skiing likely means an upper neck injury)

✅ Ask about pain—even though 50% of patients with a crooked atlas have no pain, the other half often report neck, jaw, or shoulder pain

2. Exam – Look for Physical Clues

📸 Take a photo with eyes closed – Do they have head tilt or neck translation?

🤲 Feel their neck muscles – Are they tighter on one side?

3. CBCT – The Definitive Test

If you have CBCT, take one extra minute to check their atlas and axis alignment in addition to the teeth.

Bringing It All Together

If you identify atlas misalignment, discuss it in your report of findings.

Tell your patient they should see an upper cervical chiropractor to correct it. This will:

✔ Reduce muscle tension

✔ Improve comfort during treatment

✔ Help them get the long-term results they want from their permanent retainers

At the end of the day, a crooked atlas = tight muscles, and tight muscles make your job harder. Your patients don’t want unnecessary complications—they’ll listen to you.

Finding a Specialist to Collaborate With

You need a reliable upper cervical specialist for referrals. Go to:

🔹 NUCCA.org

🔹 UCCNearMe.com

How to Reach Out

Send a message like this:

"Hi, I’m a local dentist/orthodontist looking for an atlas specialist. I’ve noticed misaligned atlases in some of my complex cases using CBCT. Let’s collaborate to help these patients achieve the best and most stable outcomes."

By working together, we can get our patients well—and keep them well.

Conclusion: Why This Matters for Your Practice

Integrating atlas screening into your patient evaluations is a game-changer.

By spending just one extra minute analyzing the atlas in CBCT scans, you can:

✔ Improve treatment efficiency ✔ Reduce complications

✔ Increase patient satisfaction

✔ Build stronger interdisciplinary collaborations

Dentists and orthodontists who understand the role of the atlas will gain a competitive edge in treating complex cases. Your patients will experience smoother treatments, faster results, and better long-term retention of their alignment.

So don’t overlook this critical factor—start incorporating atlas analysis into your CBCT workflow today!